![]() ![]() It is imperative that the clinical team informs the microbiology laboratory that S. What’s the major take home point here? If the clinical team does not tell the microbiology laboratory that Rat Bite Fever is suspected, culture methods may be insensitive and the organism may not grow. Additionally, this supplement helps to neutralize the SPS in the blood culture bottle, which many fastidious organisms have been shown to be susceptible to. Additionally, the supplement FOS (fastidious organism supplement) contains NAD and Hemin, which help support the growth of fastidious organisms and can be added to improve growth. monoliformis in blood culture, including the use of broth with low levels of SPS (anaerobic blood culture bottles often have reduced SPS) or use of resin-containing bottles. ![]() monoliformis is extremely fastidious and is inhibited by the anticoagulant sodium polyanethol sulphonate (SPS), which is used in commercial blood culture bottles.Ī number of methods can be used to enhance growth of S. However, there is a small but important caveat to this process that must be noted. Culturing the blood is the best way to isolate the organism. While the differential diagnosis of this disease may seem straightforward, culturing this organism in the laboratory can be tricky. Patients often present with symptoms that include fever, chills, joint pain and a rash that spreads across the hands and feet. This condition, most often caused by the organism Streptobacillus monoliformis, can be observed in people who have pet rats or exposure to rodents, particularly children who like to offer kisses to their furry friend and sustain bites on the lips or other parts of the face. Rat bite fever is most commonly associated with the exposure of, you guessed it, a rat bite. Culturing Streptobacillus monoliformis (Rat Bite Fever) and Other Fastidious Organisms This article includes unique methods that can be used to identify pathogens in the absence of modern technology. This is particularly relevant for laboratories that cannot afford expensive diagnostic platforms but is also applicable to well-equipped teams: in many cases, obtaining a presumptive identification of an organism using simple microbiology techniques is helpful for therapeutic decisions. Our findings indicate that 1) patients with GNB CSF shunt infections often appear relatively well at presentation 2) CSF positive for GNB by Gram's stain and very low CSF glucose levels predict continued positive CSF cultures, despite appropriate antibiotic therapy and 3) GNB CSF shunt infections can be successfully treated by prompt shunt removal, extraventricular drainage, and intravenous antibiotics.While clinical microbiologists adjust to new technologies that identify organisms with granular specificity, it is important that we retain simple identification techniques and tools in our microbial identification arsenal. One patient died of unrelated causes shortly after treatment. Only 2 of 19 patients (11%) who were followed up suffered apparent CNS damage. The overall cure rate was 100%, and no recurrence was observed however, a subsequent infection with a different organism developed in four patients. At admission, these patients had CSF glucose levels of < 10 mg/dl and CSF positive for GNB by Gram's stain. Extraventricular drainage revision and/or intraventricular antibiotics were required in four patients whose CSF cultures were persistently positive for GNB. Initial treatment always included immediate shunt removal, externalized ventricular drainage, and intravenous antibiotics. Escherichia coli was isolated from 12 of 23 patients (52%), Klebsiella pneumoniae from 5 (22%), and mixed GNB from 3 (13%) patients. The most frequent symptoms were fever, lethargy, and irritability the illness was not severe in the majority of these patients. Of these infections 20 (87%) occurred within 4 weeks after shunt revision (median, 10 days). The authors reviewed all GNB shunt infections treated at Children's Memorial Hospital from January 1986 to January 1990 (n = 23). ![]() The prognosis of CSF shunt infections caused by Gram-negative bacteria (GNB) has been thought to be particularly poor. Infection causes major morbidity and mortality in patients with cerebrospinal fluid (CSF) shunts. ![]()
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